儿童大叶性肺炎危险因素分析

Analysis of risk factors of lobar pneumonia in children

目的近年儿童大叶性肺炎(lobar pneumonia in children)的发病率急剧增加,研究目的是评估儿童大叶性肺炎的临床表现、实验室检查、影像学检查等因素和预后的关系。方法研究包括2008年1月至2009年12月在我院住院治疗的164名14岁以下大叶性肺炎患者。收集分析的医学资料包括:入院时的病史,临床特征,影像学资料,实验室数据(白细胞计数、CRP、支原体抗体、培养等)。发热持续时间和住院天数作为衡量肺炎预后的客观标准。结果儿童大叶性肺炎在肺炎中的比例从2008年的4.2%上升到2009年的14.4%。分析表明,C反应蛋白水平升高(>120 mg/L)、胸腔积液是影响大叶性肺炎预后的危险因素。长期发热是常见的大叶性肺炎住院患儿的临床特点。支原体感染在大叶性肺炎中的比例明显增加。结论入院时根据临床症状很难对大叶性肺炎的严重度做出准确判断,上述危险因素可提示大叶性肺炎的预后情况。

Purpose The incidence of lobar pneumonia in children has rapidly increased in recent years. This study aimed to evaluate the relationship between clinical manifestation, laboratory examination, imageology examination of lobar pneumonia and its progno- sis. Methods This retrospective study included 164 hospitalised patients younger than 14 years old with lobar pneumonia treated between January 2008 and December 2009. Medical records including medical hlstory, clinical signs, radiographic studies, and laboratory data （ white blood cell count, C-reactive protein, MP-Ab, culture, et al） were collected and analyzed. The duration of fever and hospitalization were regarded as objective measurements of recovery. Multiple regression analysis was performed to demonstrate the risk factors of lobar pneumonia with poor prognosis. Results The proportion of children with lobar pneumonia in children with pneumonia increased dramatically from 4.2% 2008 to 14.4% 2009. Analysis revealed the presence of elevated C-reactive protein level （ 〉 120 mg/L）, pleural effusion were independent predictors of lobar pneumonia with poor prognosis. Prolonged fever was a common clinical feature of hospitalized children with lobar pneumonia. The proportion of mycoplasma infection in lobar pneumonia increased obviously. Conclusion The severity of lobar pneumonia is difficult to judge on clinical symptoms at the time of admission. The presence of the above risk factors can help in the early diagnosis of lobar pneumonia with poor prognosis.